短时受精结合早期补救卵胞浆内单精子注射受精结局与精子因素的相关性研究OA

Objectives:To investigate the effects of sperm factors on fertilization and pregnancy outcomes in patients undergoing early rescue intracytoplasmic sperm injection(R-ICSI)after short-term insemination failure,and analyzing embryo development and clinical pregnancy outcomes after R-ICSI. Methods:A retrospective analysis of 5 891 cycles of short-term insemination combined with early R-ICSI performed at Northwest Women's and Children's Hospital between January 1,2023,and December 31,2023 was conducted.The cycles were categorized into three groups based on the final fertilization method:group A(n=5 721)with conventional IVF,group B(n=73)with partial R-ICSI,and group C(n=97)with complete R-ICSI.Basic characteristics,semen parameters,fertilization outcomes,embryo development and clinical outcomes were compared among the groups. Results:There were no statistically significant differences in terms of body mass index(BMI),endometrial thickness on the day of human chorionic gonadotropin(HCG)administration,baseline levels of luteinizing hormone(LH)and follicle-stimulating hormone(FSH),male abstinence duration,semen volume,spontaneous acrosome reaction rate,normal fertilization rate,and the proportion of cycles without transferable embryos among the three groups(P＞0.05).The mean female age in group A was significantly higher than that in group B and C(P＜0.05).The proportion of primary infertility in group A was significantly lower than that in group B and C(P＜0.05).The antagonist protocol was more frequently used in group A than in group B and C,while the long protocol was less common used in group A than in group C(P＜0.05).A significantly higher number of retrieved oocytes in group B compared to group A and C(P＜0.05).In terms of semen parameters,group A exhibited significantly higher normal morphology rate,semen concentration,sperm motility,PR-grade sperm ratio,A-grade sperm ratio and had a significantly lower sperm DNA fragmentation index compared to group B and C.Regarding fertilization outcomes,group A showed significantly higher rate of multiple pronuclei(PN)compared to group B and C,and group B also had a higher multiple PN rate than group C(P＜0.05).The 0PN rates in group A and B were significantly higher than that in group C(P＜0.05).In terms of embryo development,there were significantly higher rates of available embryos,high-quality embryos and blastocyst formation than those in group B and C(P＜0.05).The proportion of blastocyst transfers was significantly higher in group A than that in group C(P＜0.05).Group A had higher HCG positive and clinical pregnancy rates when compared with group B and C,showing no statistical significance(P＜0.05).Multivariate logistic analysis demonstrated that among sperm factors,the proportion of progressive motile spermatozoa(PR),the proportion of grade A spermatozoa,and the sperm normal morphology rate were independent influencing factors for normal fertilization in IVF(P＜0.05). Conclusions:Semen quality is still a factor in the failure of conventional IVF.Although R-ICSI can improve fertilization outcomes and avoid no available embryos transferred during the cycle,fertilization failure still negatively affects the clinical outcomes of IVF cycles.